Gnur 405 Suzy

GNUR 405
ASSIGNMENT 1
PREOPERATIVE MANAGEMENT OF NEPHRECTOMY
SPECIFICS;
1. Discuss the procedure including incision location (flank incision on affected side) and
possible tubes and drains use during or after the procedure.
2. The nurse ensure adequate fluid intake.
3. Ensure a normal electrolyte balance to prevent further complication.
4. Reporting vital abnormal laboratory values such as bacteriuria and blood coagulation
abnormalities.
5. Reduce surgery -related anxiety in the patient and family members by answering to any
question ask.
6. Inform client about possible muscle aches following the surgery due to side-lying
positioning during the surgery.
Physiologic Assessment.
Before any treatment is initiated, a health history is obtained and a physical examination is
performed during which vital signs are noted and a data base is establishing for future
comparisons.
The following are the physiologic assessments necessary during the preoperative phase:
 Obtain a health history and perform a physical examination to establish vital signs
and a database for future comparisons.
 Assess patient’s usual level of functioning and typical daily activities to assist in

patient’s care and recovery or rehabilitation plans.
 Assess mouth for dental caries, dentures, and partial plates. Decayed teeth or
dental prostheses may become dislodged during intubation for anaesthetic delivery
and occlude the airway.
 Nutritional status and needs – determined by measuring the patient’s height and
weight, triceps skinfold, upper arm circumference, serum protein levels and
nitrogen balance. Obesity greatly increases the risk and severity of complications
associated with surgery.
 Drug and alcohol use – the acutely intoxicated person is susceptible to injury.
 Respiratory status – patients with pre-existing pulmonary problems are evaluated

by means pulmonary function studies and blood gas analysis to note the extent of
respiratory insufficiency.
 Cardiovascular status – cardiovascular diseases increase the risk of complications.

Depending on the severity of symptoms, surgery may be deferred until medical
treatment can be instituted to improve the patient’s condition.
 Immunologic function – existence of allergies, previous allergic reactions,

sensitivities to certain medications, past adverse reactions to certain drugs,
immunosuppression
 Previous medication therapy – It is essential that the patient’s medication history

be assessed by the nurse and anaesthesiologist.
Diagnostic Tests
These diagnostic tests may be carried out during the perioperative phase:
 Blood analyses such as complete blood count, sedimentation rate, c-reactive

protein, serum protein electrophoresis with immune fixation, calcium, alkaline
phosphatase, and chemistry profile.
 Urinalysis.
Psychological Care:
This care is aimed at helping the patients and family understand and accept the surgery
(nephrectomy) and also relieves the fear and stress associated of surgery.
1. Reassure patient and family that with modern technology, surgery is safe, post – operative
pain will be controlled with analgesics and the patient is in competent health personnel.
2. Assess patient and family knowledge and misconceptions about the surgery. Reinforce
surgeon’s explanation of the surgery to the patient and family in simple terms and in the
language they understand. Allow them to ask questions and answer in simple terms.
3. Patient and family is introduced to another patient who has undergone a similar surgery
successfully and encourage an interaction between the patients or family members to help
relieve anxiety.
4. Patient and family is also introduced to gadgets that will be used for the patient pre-
operatively and post -operatively so that after the anesthesia wears off, he will not be scared..
5. Patient is oriented to the surgery team and the hospital environment to assist in care
activities.
6. Patient and family is assisted to meet their spiritual needs.
7. Patient is assisted to sign or thumbprint the consent form.
Teaching Deep Breathing and Coughing Exercises.
 Teach the patient how to promote optimal lung expansion and consequent blood
oxygenation after anaesthesia by assuming a sitting position, taking deep and slow
breaths (maximal sustained inspiration), and exhaling slowly.
 Demonstrate how patient can splint the incision line to minimize pressure and
control pain.
 Inform patient that medications are available to relieve pain and that they should
be taken regularly for pain relief to enable effective deep breathing and
coughing exercises.
Explaining Pain Management
 Instruct patient to take medications as frequently as prescribed during the initial

postoperative period for pain relief.
 Discuss the use of oral analgesic agents with patient before surgery, and assess
patient’s interest and willingness to participate in pain relief methods.
 Instruct patient in the use of a pain rating scale to promote postoperative pain

management.
Remove jewellery, including wedding rings
 If patient objects, securely fasten the ring with tape.
 Give all articles of value, including dentures and prosthetic devices, to family

members, or if needed label articles clearly with patient’s name and store in a safe
place according to hospital policy.
B) MONITORING RECIPIENT COMPLICATIONS AFTER KIDNEY

TRANSPLANT.
1.Infection
Transplant patients are at a greater risk of infection because of the need for
immunosuppression, which weakens their immune system and ability to fight infection.
While it is important for you to limit contact, with potentially infectious situations, it is not
necessary to become a recluse! There are some relatively simple measures which you can
take to reduce the risk of infection, without unduly limiting your lifestyle.
How to monitor.
a. Check for signs of inflammation at the incisional site.
b. Observe for discharges from the wound.
c. Check and record vital signs including blood pressure, pulse, temperature and respiration
and report and deviation from normal.
d. Take sample to the laboratory for further investigation if any serve prescribes antibiotics.
e. Monitor wound closely.
2. Rejection
Kidney transplant rejection means that your immune system is 'confused' and attacks your
kidney, thinking it is attacking a group of bacteria, infecting your body. Rejection may sound
quite dramatic but, in fact, it is very common and, fortunately, in most cases, when rejection
is discovered and treated early, it can be controlled.
How to monitor your risk of rejection:
 Take your medication as prescribed and directed;

 Learn the early warning signs of rejection,
 Reduce in amount of urine output.
 Check for difficulty in breathing.
 Check out for Sudden weight gain or swelling of hands, feet, legs or eyelid
 Check for Elevated blood pressure.
3. Acute Tubular Necrosis or delayed graft function: This occurs as a result of factors
related to the donor the donor such as low blood pressure during CPR. It may also happen if
the kidney has being stored for some hours after removal from the donor.it may also happen
the recipient has unexpected bleeding during surgery.
How to monitor.
 Check vital signs and report any changes.

 Check for signs and symptoms of necrosis such as decreased consciousness.
 Check out for urine output or no urine output.
 Monitor for fluid retention or General swelling
REFERENCES
1.Merrill JP, Murray JE, Harrison JH. Successful homotransplantations of the human kidney
between identical twins. JAMKidney Disease: Improving Global Outcomes (KDIGO)
Transplant Work Group.
2.Hansen M. Disorders of renal and urinary function, Pathophysiology: Foundations of

Disease and Clinical Intervention. Philadelphia, Pa: W B Saunders Company; 1998.
3.Kiberd BA, Clase CM. Cumulative risk for developing end-stage renal disease in the US
population. J Am Soc Nephrol. 200213:1635-1644.
4.US Renal Data System: Excerpts from the USRDS 2001 Annual Data Report: Atlas of End-
Stage Renal Disease in the United States. Am J Kidney Dis. 2001;38:S1-S248.
5.Fauci AS, Braunwald C, Isselbacher KJ, et al, eds. Dialysis and Transplantation in the
Treatment of Renal Failure (14th ed). New York, NY: McGraw-Hill; 1998.

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GNUR 405

PREOPERATIVE MANAGEMENT OF NEPHRECTOMY

2. The nurse ensure adequate fluid intake.

3. Ensure a normal electrolyte balance to prevent further complication.

 Assess patient’s usual level of functioning and typical daily activities to assist in

 Respiratory status – patients with pre-existing pulmonary problems are evaluated

 Cardiovascular status – cardiovascular diseases increase the risk of complications.

 Immunologic function – existence of allergies, previous allergic reactions,

 Previous medication therapy – It is essential that the patient’s medication history

 Blood analyses such as complete blood count, sedimentation rate, c-reactive

6. Patient and family is assisted to meet their spiritual needs.

7. Patient is assisted to sign or thumbprint the consent form.

Teaching Deep Breathing and Coughing Exercises.

Explaining Pain Management

 Instruct patient to take medications as frequently as prescribed during the initial

 Instruct patient in the use of a pain rating scale to promote postoperative pain

Remove jewellery, including wedding rings

 If patient objects, securely fasten the ring with tape.

 Give all articles of value, including dentures and prosthetic devices, to family

B) MONITORING RECIPIENT COMPLICATIONS AFTER KIDNEY

a. Check for signs of inflammation at the incisional site.

b. Observe for discharges from the wound.

e. Monitor wound closely.

How to monitor your risk of rejection:

 Take your medication as prescribed and directed;

 Check vital signs and report any changes.

2.Hansen M. Disorders of renal and urinary function, Pathophysiology: Foundations of

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